Low- and medium-molecular-weight hydroxyethyl starches - Comparison of their effect on blood coagulation

被引:69
作者
Jamnicki, M
Bombeli, T
Seifert, B
Zollinger, A
Camenzind, V
Pasch, T
Spahn, DR
机构
[1] Univ Spital Zurich, Inst Anasthesiol, CH-8091 Zurich, Switzerland
[2] Univ Spital Zurich, Dept Internal Med, CH-8091 Zurich, Switzerland
[3] Univ Spital Zurich, Dept Biostat, CH-8091 Zurich, Switzerland
关键词
colloids; hemodilution; Thrombelastograph (R) analysis;
D O I
10.1097/00000542-200011000-00016
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than medium-molecular-weight HES. The authors compared medium molecular weight HES (200 kd [HES200]) and low-molecular-weight HES (70 kd [HES70]). Methods: In a prospective, double-blind, randomized-sequence crossover study, 22 male volunteers received 15 ml/kg HES200 and HES70. Blood samples were taken before and 5 min, 30 min, 1 h, 2 h, 4 h, 8 h, and 24 h after Infusion. The following parameters were analyzed at all time points: prothrombin time, activated partial thromboplastin time, fibrinogen, factor VIII, antigenetic and functional von Willebrand factor, platelets, Thrombelastograph(R) analysis parameters (reaction time, coagulation time, maximum amplitude, angle cu, and clot lysis 30 and 60 min after maximum amplitude), ionized calcium, hematocrit, HES plasma concentration, molecular weight (R eight average and number average), molar substitution, and polydispersity (weight average/number average). Repeated-measures analysis of variance (P < 0.05) was used to compare the response of the aforementioned parameters to the infusion of HES70 and HES200. Results: Both HES solutions had a significant impact on all parameters. A slightly greater compromise with HES200 was found in activated partial thromboplastin time (P = 0.010), factor VIII (P = 0.009), antigenetic von Willebrand factor (P = 0.041), functional von Willebrand factor (P = 0.026), maximum amplitude (P = 0.008), and angle ly (P = 0.003). No difference was established with the other parameters, HES concentration (P < 0.001), weight average (P < 0.001), number average (P < 0.001), and polydispersity (P < 0.001) were higher with HES200. There was no difference with molar substitution (P = 0.091). Conclusions: Low-molecular-weight hydroxyethyl starch (70 kd) compromises blood coagulation slightly less than HES200, but it is unclear whether this is clinically relevant.
引用
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页码:1231 / 1237
页数:7
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